Action Points

Advise patients that even though they have a completely blocked artery they can still achieve a robust quality of life with proper medical therapy.

Note that this study was published as an abstract at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed publication.

ORLANDO, Nov. 7 -- It costs about $7,000 more over two years to open occluded coronary arteries than to treat MI patients with medication alone, and stenting offers little gain in quality of life, researchers said here.

A follow-up analysis of the Occluded Artery Trial (OAT) found that percutaneous coronary intervention (PCI) with stenting at three to 28 days after a heart attack was not an economically efficient way to improve health outcomes in patients with coronary blockage, Daniel Mark, M.D., of Duke University, told attendees at the American Heart Association meeting.

"The small symptom benefits provided were insufficient to make percutaneous coronary intervention an economically attractive strategy in OAT eligible patients," said Dr. Mark.

OAT was a prospective, randomized, multicenter trial comparing late percutaneous coronary intervention with medical therapy alone in 2,166 heart attack patients who had a total blockage in a major coronary artery. Patients were eligible for OAT if they had not received effective therapy to open the blocked artery within the first 12 hours after symptom onset.

"The overall goal of this [subanalysis] was to compare cost and quality-of-life outcomes in patients randomized to the two arms of OAT," said Dr. Mark.

OAT patients were about 59 years old; 83% were Caucasian, and 78% were male. All patients were considered high-risk but stable without evidence of severe ischemia.

Researchers obtained quality-of-life data from 951 patients at the start of the study, then again during follow-up interviews at four months, one year, and two years after enrollment.

Dr. Mark said that costs of treatment during the first 30 days was $22,859 for patients undergoing angioplasty plus stenting compared with $12,683 for those getting medical treatment only.

Over the rest of the study period, costs were higher for those treated medically. For the rest of the first year, their costs totaled $5,290 compared with $3,413 for patients who had the invasive procedure.

In the second year, costs for the medically treated patients were $2,809 compared with $1,560 for the angioplasty/stent patients.

From initial treatment to end of the study period, however, there was an overall savings of $7,050 by going the medical rather than the mechanical route.

Percutaneous coronary intervention was associated with a clinically significant benefit in physical functioning at four months, but this benefit was not sustained at one year or beyond.

There were no significant effects on psychological well-being.

Of the secondary quality-of-life outcomes, angioplasty was associated with a modestly lower level of angina at four months and one year but these benefits also diminished over time.

"The OAT trial showed that there was no benefit in individuals who had percutaneous interventions compared with medical therapy three to 28 days after their myocardial infarction," said Nieca Goldberg, M.D., of New York University, commenting on the study.

"This subanalysis showed that there was no benefit in survival -- just a modest benefit in symptoms and no improvement in quality of life. In addition, those who underwent interventions actually had a higher cost for their hospitalization than those who were given medical therapy."

Dr. Goldberg said that new suggestions for extending clopidogrel treatment for patients with drug-eluting stents might increase the post-hospital costs of patients who have interventions -- making the medical treatment even more attractive for this group of heart attack patients.

Support for this study was provided by Boston Scientific (Argentia), Cordis, Eli Lilly, and Guidant.

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